Why do nursing students fail the NCLEX-RN Exam?

Kelly J. Betts, Ed.D, RN, CNEAshley Davis, MNSc, RN, CNE

Stanley K. Ellis, Ed.DUniversity of Arkansas for Medical Sciences

College of Nursing & Office of Educational Development

ACKNOWLEDGEMENTS

• Sigma Theta Tau, Gamma Xi Chapter-UAMS College of Nursing Grant Funding

• UAMS Educators Academy Grant Funding

• Cynthia Mercado, Statistician

• UAMS CON BSN Graduates

Problem

• 5-15% of students fail the NCLEX-RN on the first attempt

• Lowers Pass Rates

• Gap in Knowledge

• No exact model for success

Purpose

• The purpose of this study was to identify any trends or patterns that may have contributed to BSN graduates that were not successful on the first or subsequent attempts at the NCLEX-RN Exam.

Objectives

• Determine if students who have failed the NCLEX-RN Exam after graduation exhibit trends or patterns in academic performance using variables such as the TEAS V Entrance Exam Scores, Critical Thinking Exam Scores, and the RN Predictor Standardized Exam Scores.

• Evaluate graduated students’ experiences on what challenges they felt led to not being successful on the NCLEX-RN Exam using qualitative interviewing.

• Based on the results of the study, identify academic coaching measures that will enhance future success with at risk students prior to graduation.

Research Questions

• What are the academic characteristics of these students while they are in the BSN program related to academic success?

• What are the contributing factors that cause students to be unsuccessful on the NCLEX-RN Exam?

• What are students’ perceptions of the causes of their failure on the NCLEX-RN Exam?

• Are there social and academic patterns demonstrated during the BSN program that contribute to this failure?

Methods• Mixed Methods

– Descriptive, Logistic Regression, and correlational methods

– Face to face interviewing and Thematic Analysis

• Subjects/Setting

– Graduates from May 2012-May 2016

– UAMS College of Nursing Students

• Instruments:

– SPSS™, Ethnograph™, Interview Guide, Transcription

• Quantitative Variables Measures (Academics)

– TEAS V Admission Exam Scores

– ATI Critical Thinking Exit Exam Scores

– ATI RN Predictor Exam Scores

– Admission GPA

– Graduation GPA

– Number of Academic Coaching Sessions attended

– Did they fail a course in the program?

Student Demographics• A convenience sample of 46 subjects was included in the study of which a

majority 72% (33) were female and 28% (13) were male. Caucasians represented 78% (36) and African-Americans, 22% (10).

• Academics: The UAMS College of Nursing established a minimum score of 65 or greater TEAS Score for admission to the program. Sixty-one percent (28) had scores of >65 in their TEAS while 39% (18) scored less than the cut-off score.

• The students started off with admission GPA’s of 3.21 ± 0.36 and graduated with cumulative scores of 2.83 ± 0.36. T-test analysis showed a significant difference between the two sets of scores (t=, df = 45, p=<0.001)

• Of the 46 students included in the study, 37% (17) failed a course while the majority, 63% (29) passed the course.

• More than 75% of the students passed the TEAS on the first try, 17% attempted twice and only 4% took the TEAS for third and fourth attempts.

Results: Quantitative

TEAS Exam Scores Mean s.d.

TEAS Reading 76.1% 8.9%

TEAS Math 67.6% 11.7%

TEAS Science 55.8% 10.5%

TEAS English 68.2% 12.5%

Table 1. Means and Standard Deviations of ATI TEAS Exam Score (N=46)

Results: Quantitative

Variables Mean s.d. Minimum Maximum

Comprehensive Predictor Exam Score 66.7 6.1 54.7 82.0

Critical thinking entrance score 69.7 8.0 47.5 85.0

Critical thinking exit score 72.0 13.0 .0 90.0

Fundamental Exam Score 65.2 6.7 51.7 75.0

Fundamental Exam level 1.4 .7 .0 2

Medical surgical Score 53.5 6.6 38.9 65.6

Medical surgical Exam level .4 .5 .0 1

Pediatrics Exam Score 59.4 7.2 40.0 71.7

Pediatrics Exam level 1.3 .6 .0 2

Obstetrics Exam Score 66.9 9.5 36.7 83.3

Obstetrics Exam level 1.7 .8 .0 3

Psych Mental Health Score 69.6 9.0 46.7 86.7

Psych Mental Health level 1.8 .7 .0 3

Pharmacology Exam Score 59.9 8.7 43.3 78.3

Pharmacology Exam level 1.2 .6 .0 2

Table 2. Means, Standard Deviations, Minimum & Maximum Scores of Academic &Nursing Variables (N=46)

Results: Major Themes

• Lack of student preparation

• Anxiety (emotions)

• Testing Environment Differences

• Length of time to test post graduation

• Lack of student accountability

• Differences between program exam questions and NCLEX questions

Results: Student QuotesPreparation Emotions Testing

Experience

Self-

Accountability

Length of Time to

Test

Question

Differences

“I studied about

maybe two hours

every day, but

only a couple of

weeks prior to

the test.”

“I was very

nervous. I’m a

bad test-taker to

begin with.”

“Well in my

nursing program I

tested in a private

room. I was able

to drink

water…my NCLEX

testing was totally

different…”

“X told me “this is

going to be your

first failure”…I

had to remediate

but I don’t think I

would say that to

any student”.

I graduated in

May, and then I

took it in

November and

did not pass

“…the way the

questions are

written…in our

nursing school of

tests and exams it

was pretty

straight

forward…the

NCLEX questions

needed more

critical thinking..”

“I did not do too

much to

prepare… I

worked a lot so I

would study an

ATI book

occasionally in

my free time on a

night shift.”

“I’m a little bit

angry. I went into

that test… not as

prepared… that

way, I kind of fully

expected not to

pass it.”

”…You’ve got to

go through this

whole re-

entrance, they

pat you down to

make sure you

have nothing on

you, scan your

fingers again and

then let us into

the testing site…”

“The predictor

said that I had a

99% chance of

passing. Because

of this I thought

that I wouldn’t

have a problem

passing the test.

The second time

around though I

did a HURST

review and it

helped

tremendously.”

“…I waited 4

months to take

the exam and I

feel like I would

have passed it

with no issues if I

had taken it

sooner.”

“I had a lot of

med surg

questions. A lot of

them were select

all that apply. I

didn’t expect to

have that many

but probably

every 5th question

was SATA.”

Conclusions

• The Medical Surgical exam proved challenging for the students classified in Level 0, with maximum scores of 65.6%

• Psychiatric Mental Health Exams Scores were higher and correlated with whether or not the student passed or failed a nursing course.

• There were no significant correlations between the pre-nursing GPA and the six nursing variables (ATI Standardized Exam Scores)

• Correlations between Academic and Nursing Variables showed a p-value of 0.02 between the ATI PMH Exam and the TEAS Reading Scores

• Limitation: Study was underpowered, need more students to see if there would have been differences in the correlations between variables.

Implications for Nursing Education

• Model institution testing environment like the NCLEX-RN testing environment

• Ensure that course exam questions are written in a format similar to the NCLEX-RN Exam with the same level of critical thinking as the NCLEX-RN questions.

• Reduce the length of time between graduation and taking the exam for the first time

• Encourage students who have special testing in the nursing program to continue with special testing accommodations when taking the NCLEX-RN Exam

• Evaluate “Out of Sync Students” and ways to limit the amount of time they have to repeat courses.

References

• Breckenridge, D.M., Robinson-Wolf, Z., & Roszkowski, M.J. (2012). Risk assessment profile and strategies for success instrument: Determining prelicensure nursing students’ risk for academic success. Journal of Nursing Education, 51(3), 161-166. doi:10.3928/01484834-20120113-03

• McCarthy, M., Harris, D., & Tracz, S. (2014). Academic and nursing aptitude and the NCLEX-RN in baccalaureate programs. Journal of Nursing Education, 53(3), 151-159. doi:10.3928/01484834-20140220-01